Emergency Care For You

Be Prepared

Learn How to Peform CPR

Learning how to perform cardio-pulmonary resuscitation (CPR) saves lives. While no statistics are available on the exact number of lives sudden cardiac arrest claims per year, approximately 335,000 people die annually of coronary heart disease without being hospitalized – or about 918 Americans each day, according to the American Heart Association (AHA).

Conventional CPR consists of chest compressions and rescue breathing. The American Heart Association continues to support this approach to CPR, but recent research demonstrates that rescue breathing may be unnecessary and potentially detrimental in cases of cardiac arrest. In the interest of presenting complete information, however, ACEP is including instructions on how to provide rescue breaths in this guide for laypersons who choose to employ them.

The tips provided below are based on procedures recommended by the AHA and are not a substitute for formal training in CPR. The AHA and the American Red Cross offer CPR courses; to register, contact the AHA at 1-800-AHA-USA1 or your local American Red Cross chapter. Everyone in your family should take one of these courses, and you should have your CPR skills tested at least every two years.

Automated External Defibrillators (AEDs) are increasingly available at many locations, such as shopping malls and airports. They are small, lightweight devices used to assess a person's heart rhythm. An AED can detect the need for and administer an electric shock to restore a normal heart rhythm in people with sudden cardiac arrest. ACEP supports widespread distribution of AEDs, as long as it is coordinated with existing EMS systems and includes proper training. Logical places for AEDs include police cars, theaters, sports arenas, public buildings, business offices and airports. An increasing number of commercial airplanes are now equipped with AEDs and enhanced medical kits.

CPR is typically administered in cases of cardiac arrest. Signs of cardiac arrest include an absence of heartbeats, blood flow and pulse. When blood stops flowing to the brain, the person becomes unconscious and stops regular breathing.

The ABCs of CPR

The ABCs of CPR are Airway, Breathing, and Circulation. This acronym is used to help you remember the steps to take when performing CPR.

Airway

  • If a person has collapsed, determine if the person is unconscious. Gently prod the victim and shout, "Are you okay?" If there is no response, shout for help. Call 911 or your local emergency number.
  • If the person is not lying flat on his or her back, roll him or her over, moving the entire body at one time.
  • Open the person's airway. Lift up the chin gently with one hand while pushing down on the forehead with the other to tilt the head back. (Do not try to open the airway using a jaw thrust for injured victims. Be sure to employ this head tilt-chin lift for all victims, even if the person is injured.)
  • If the person may have suffered a neck injury, in a diving or automobile accident, for example, open the airway using the chin-lift without tilting the head back. If the airway remains blocked, tilt the head slowly and gently until the airway is open.
  • Once the airway is open, check to see if the person is breathing.
  • Take five to 10 seconds (no more than 10 seconds) to verify normal breathing in an unconscious adult, or for the existence or absence of breathing in an infant or child who is not responding.
  • If opening the airway does not cause the person to begin to breathe, it is advised that you begin providing rescue breathing (or, minimally, begin providing chest compressions).

Breathing (Rescue Breathing)

Pinch the person's nose shut using your thumb and forefinger. Keep the heel of your hand on the person's forehead to maintain the head tilt. Your other hand should remain under the person's chin, lifting up.

  • Inhale normally (not deeply) before giving a rescue breath to a victim.
  • Immediately give two full breaths while maintaining an air-tight seal with your mouth on the person's mouth. Each breath should be one second in duration and should make the victim's chest rise. (If the chest does not rise after the first breath is delivered, perform the head tilt-chin lift a second time before administering the second breath.) Avoid giving too many breaths or breaths that are too large or forceful.

Circulation (Chest Compressions)

After giving two full breaths, immediately begin chest compressions (and cycles of compressions and rescue breaths). Do not take the time to locate the person's pulse to check for signs of blood circulation.

  • Kneel at the person's side, near his or her chest.
  • With the middle and forefingers of the hand nearest the legs, locate the notch where the bottom rims of the rib cage meet in the middle of the chest.
  • Place the heel of the hand on the breastbone (sternum) next to the notch, which is located in the center of the chest, between the nipples. Place your other hand on top of the one that is in position. Be sure to keep your fingers up off the chest wall. You may find it easier to do this if you interlock your fingers.
  • Bring your shoulders directly over the person's sternum. Press downward, keeping your arms straight. Push hard and fast. For an adult, depress the sternum about a third to a half the depth of the chest. Then, relax pressure on the sternum completely. Do not remove your hands from the person's sternum, but do allow the chest to return to its normal position between compressions. Relaxation and compression should be of equal duration. Avoid interruptions in chest compressions (to prevent stoppage of blood flow).
  • Use 30 chest compressions to every two breaths (or about five cycles of 30:2 compressions and ventilations every two minutes) for all victims (excluding newborns). You must compress at the rate of about 100 times per minute.
  • Continue CPR until advanced life support is available.
  • Using an AED in conjunction with CPR:
  • If using an AED in the case of a heart attack or cardiac arrest, single shocks should be followed by immediate CPR for two minutes. Heart rhythm checks should be performed every two minutes (or after giving about five cycles of CPR); the AED will provide audible prompts at the appropriate intervals. See AED section for details.
  • If using an AED on a one- to eight-year-old child, use a child-dose-reduction system if available. (However, do not use child pads or a child dose on adults in cardiac arrest because the smaller dose may not defibrillate adults properly.)

CPR for Infants (Up to One Year Old)

Airway

With infants, be careful not to tilt the head back too far. An infant's neck is so pliable that forceful backward tilting might block breathing passages instead of opening them.

Breathing

Do not pinch the nose of an infant who is not breathing. Cover both the mouth and the nose with your mouth and breathe slowly (one to one and a half seconds per breath), using enough volume and pressure to make the chest rise.

With a small child, pinch the nose closed, cover the mouth with your mouth and breathe at the same rate as for an infant. Rescue breathing should be done in conjunction with chest compressions. (See next section.)

Chest Compressions on Infants

  • If alone with an unresponsive infant, give five cycles of CPR (compressions and ventilations) for about two minutes before calling 911 or your local emergency number.
  • Use only the tips of the middle and ring fingers of one hand to compress the chest at the sternum (breastbone), just below the nipple line, as described in the table below. The other hand may be slipped under the back to provide a firm support. (However, if you can encircle your hands around the chest of the infant, using the thumbs to compress the chest, this is better than using the two-finger method.)
  • Depress the sternum between a third to a half the depth of the chest at a rate of at least 100 times a minute.
  • Two breaths should be given during a pause after every 30 chest compressions on all infants (excluding newborns).
  • Continue CPR until emergency medical help arrives.
  • Small Children (ages one to eight)
  • Give five cycles of CPR (compressions and ventilations) for about two minutes before calling 911.
  • Use the heel of one or two hands, as needed, and compress on the breastbone at about the nipple line.
  • Depress the sternum about a third to a half the depth of the chest, depending on the size of the child. The rate should be 100 times per minute.
  • Give two breaths for every 30 chest compressions (30:2 ratio).
  • Continue CPR until emergency medical help arrives.

Automatic External Defibrillators

Main Points

  • Each year in the U.S., there are approximately 360,000 EMS-assessed cardiac arrests outside of a hospital setting and on average, less than 10% of victims survive.
  • Having more people who can respond to medical emergencies and trained to use AEDs will greatly increase survival rates for people in sudden cardiac arrest.
  • When a person suffers a sudden cardiac arrest, chances of survival decrease by 7 to 10 percent for each minute that passes without defibrillation. A victim's best chance for survival is when there is revival within 4 minutes.
  • The American College of Emergency Physicians supports increased public access to AEDs that is coordinated with community EMS systems and with appropriate training.
  • AEDs are most effective when standards are in place for appropriate training, equipment maintenance and ongoing monitoring of the quality of care.

Q.

What is an Automated External Defibrillator?

A.

An Automated External Defibrillator (AED) is a small, lightweight device used to assess a person's heart rhythm. If necessary, it administers an electric shock to restore a normal rhythm in victims of sudden cardiac arrest.. Built-in computers assess the patient's heart rhythm, judge whether defibrillation is needed, and then administer an appropriate level of shock. Audible and/or visual prompts guide the user through the process.

Q.

How does an AED work?

A.

A microprocessor inside the defibrillator analyzes the victim's heart rhythm through adhesive electrodes (some AED models require the person to press an ANALYZE button). The computer then advises the operator whether a shock is needed. When the operator responds to the prompt to give a shock, an electric current is delivered through the victim's chest wall through adhesive electrode pads.

Q.

Why are AEDs important?

A.

AEDs can restore a normal heart rhythm in victims of sudden cardiac arrest, which may be a heart attack or sudden death. New, portable AEDs enable more people to respond to a medical emergency that requires defibrillation.
When a person suffers a sudden cardiac arrest, the chance of survival decreases by 7 percent to 10 percent for each minute that passes without defibrillation. The American Red Cross estimates that 50,000 lives could be saved each year if AEDs were widely used.

Q.

Who can use an AED?

A.

Anyone trained to use cardiopulmonary resuscitation (CPR) can be trained to use an AED. Most AEDs are designed to be used by people without medical backgrounds, such as police, firefighters, flight attendants, security guards, and lay rescuers. AEDs are most effective when standards are in place for appropriate training, equipment maintenance and ongoing quality-of-care monitoring.

Q.

When a person's heart stops beating, why should an AED be used?

A.

When a heart's rhythm goes into an uncoordinated electrical activity called fibrillation, the heart twitches ineffectively and can't pump blood. This condition often accompanies severe heart attacks when the patient's heart appears to have stopped beating.
The AED delivers electric current to the heart muscle, momentarily stunning the heart, stopping all activity. This gives the heart an opportunity to resume beating effectively.

Q.

Will an AED always resuscitate someone in cardiac arrest?

A.

No. The AED treats only a heart in ventricular fibrillation, an irregular heart rhythm. In cardiac arrest without ventricular fibrillation, the heart does not respond to electric currents, but needs medications. The victim also needs breathing support. AEDs are less successful when the victim has been in cardiac arrest for more than a few minutes, especially if no CPR was provided.

Q.

Should AEDs be available on airplanes and in other public places?

A.

Yes. Since seconds count when a person experiences a heart attack, ACEP supports widespread distribution of AEDs, as long as it is coordinated with existing EMS systems and includes proper training. Logical places for AEDs include police cars, theaters, sports arenas, public buildings, business offices and airports. An increasing number of commercial airplanes are now equipped with AEDs and enhanced medical kits.
Approximately 200,000 people die from cardiac arrest every year. The broad deployment of a new generation of portable defibrillators for use by trained lay rescuers can help to save countless lives from this deadly and unpredictable event.
Chicago's O'Hare International and Midway Airports were the first airports in the United States to provide defibrillators to employees. Some companies may be concerned about liability from employees using AEDs, but many states already have passed Good Samaritan laws to protect laypersons. Most states have such laws.

Q.

Do AEDs replace the use of CPR?

A.

No. When a person experiences cardiac arrest, CPR will help keep oxygen flowing to the brain, but the electric shock of an AED vastly improves the chances of restarting the heart. AEDs can be used as part of cardiopulmonary resuscitation. CPR is still needed, starting with determining whether a person is unconscious, breathless, or pulseless.
To help spread the use of AEDs, the American Red Cross has incorporated AED training into standard CPR training for the nation's businesses. The American Red Cross trains approximately 6 million people each year in lifesaving first aid and CPR.

Q.

What's the difference between an AED and the defibrillators used in hospitals?

A.

In-hospital defibrillators are manual, larger than AEDs, and designed to be used only by qualified medical personnel with special training to use the device and to recognize heart rhythms. Medical personnel who use the device must decide whether or not to shock the person. Manual defibrillators also have additional capabilities such as pacing and cardioversion.
AEDs are programmed to recognize different heart rhythms and to make the shock/no shock decision, so that users don't have to. They were designed so that lifesaving defibrillation could be performed as quickly as possible.

MedicAlert: How They Can Help in a Medical Emergency

Most people assume that if they end up in the emergency room, they'll be alert enough to tell the staff everything they need to know about their medical history, and current medications and conditions. But what if you're seriously ill or even unconscious?

In an emergency, it is critical for first responders and the ER staff to know your medical information in order to treat your emergency properly – so critical, in fact, it can mean life or death.

For example, some drug interactions can be deadly. Knowing what medications you're currently taking is essential – and so is knowing what, if any, drugs you are allergic to. Your medical team also needs to know what current medical conditions you have, recent surgeries, and family medical history.

So, if you were unable to communicate during a medical emergency, do you know who would speak for you?

Betty Edwards of Savannah, Ga., knows who spoke for her husband, George, when on an out-of-town trip he collapsed in a restaurant. When paramedics arrived they immediately noticed his MedicAlert bracelet and called. Within precious seconds, they were given a list of George's medications. At the emergency department, doctors determined George had suffered a mild stroke. But, according to one of the doctors who treated him, had it not been for MedicAlert they would have never known he was on blood-thinning medication for his heart – and not knowing that could have caused the treatment to go horribly wrong.

The Coopers also use MedicAlert. Dan Cooper's mother, Julie Ann, is epileptic and, one day, the one thing they feared most happened. Julie Ann was in line at the post office when she fell to the ground in violent convulsions. MedicAlert was able to give paramedics a complete list of Julie Ann's medications and medical conditions, which allowed them to quickly treat her. MedicAlert even called Dan to alert him of his mother's emergency.

MedicAlert is a nonprofit Foundation that provides critical medical information to emergency personnel who call their 24-hour, live-response hotline. And emergency personnel are trained to look for the MedicAlert bracelet that has the toll-free hotline and is engraved with key medical information, such as the person's most critical condition. For more than 50 years since its founding, MedicAlert has helped to save a countless number of lives.